Battling malaria with treated bednets

Stephen Dale
Lasting impacts

Among the best news of this century is that malaria deaths fell by 25% between 2000 and 2010, to 655,000 a year. The roots of this achievement can be traced back to the 1990s when IDRC and the World Health Organization began supporting research on how insecticide-treated bednets could help reduce malaria’s relentless toll.

Those nets have proven crucial to the global anti-malaria campaign, which has been especially effective in Africa. A study published in the March 2012 Malaria journal, for example, concludes that treated bednets accounted for 99% of child malaria deaths estimated to have been prevented in sub-Saharan Africa in recent years.

This remarkable outcome defies earlier expectations. In the early 1990s, bednets were of only marginal interest to most international health organizations, recalls former IDRC health specialist Don de Savigny. But groundbreaking research soon helped move treated nets onto the global agenda.

Large-scale studies

Since the 1980s, it had been known that insecticides on nets could kill malaria-carrying mosquitoes. It was also known that treated bednets could diminish an individual’s susceptibility to contracting malaria, recounts de Savigny, now a Basel-based professor of epidemiology and long-term advisor to WHO and Roll Back Malaria. But what remained unknown was whether using the nets could actually reduce the overall death rate.

With that question in mind, in the early 1990s IDRC and the WHO co-funded large-scale trials of the nets in Africa, and in 1994 convened a conference of experts to map a way forward. The 1996 publication of the research findings and recommendations in the IDRC book
Net Gain alerted the world to the treated nets’ life-saving potential.

It would be logical for the role of research to end there, but IDRC-supported researchers had a different idea. They moved on to a new research agenda focusing on the “how” of fighting malaria with the bednets. Major practical questions remained: how to encourage people to obtain and use the nets, how to distribute them to millions of people, how to encourage their manufacture, and how to finance the whole endeavour.

Spurred an industry

IDRC-funded research produced a series of concrete solutions. In Tanzania, a social-marketing program was devised to educate citizens on the wisdom of buying the nets, which were subsidized so more people could afford them.  An infusion of cash from the Global Fund to Fight Aids, Tuberculosis and Malaria in 2004 made it possible to distribute high-value discount vouchers for treated bednets as part of the health system, which has facilitated much greater access for the poor.

Researchers also visited factories to make the economic case for bednet production, spurring the growth of a huge manufacturing industry. They also developed home treatment kits so people could reapply insecticides to older nets, extending their effectiveness. (These have since been replaced by a current generation of “long-lasting insecticidal nets.”)

All this work primed the pump, de Savigny notes, by creating an initial demand for the nets and indicating what a comprehensive, net-centred strategy might look like. Within the large, multi-player global effort to combat malaria, IDRC played a crucial role as “a trailblazer and a pathfinder,” he says.

Still, the struggle against malaria demands vigilance and constant innovation. Recent localized evidence of mosquitoes developing resistance to today’s insecticides, for instance, shows that new drugs, insecticides, and strategies are needed. Such resistance “is normal and expected,” says de Savigny, “and it shows why continued discovery and research is needed.”

Stephen Dale is an Ottawa-based writer.

This story is part of the Lasting Impacts series that highlights how IDRC-funded research has improved lives in the developing world.

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